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rP r� APPLICATION - USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: UP--. <br /> a <br /> Other <br /> Describe any items of historical or archaeological.interest on-site e. , cemeteries or structures): <br /> NO Af <br /> Describe any on-site or off-site sources of noise or vibration (e.g. freewaynoise, hea equipment, etc. : <br /> AJF <br /> e t <br /> Describe any on-site or off-site sources of light of glare(e.g. parkinglot lighting,or reflective materials used): <br /> i I PA),E <br /> Describe any on-site or off-site source of odor e.q. agricultural wastes): <br /> i OA)F <br /> Describe any displacement of people that will be caused by the project e.g. numbers of people, housing units): <br /> /IlrA),E <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> employees from any claim, action or proceeding against the Owner/Agent's project. <br /> 1, further, certify under penalty of perjury that I am (check one): <br /> r, <br /> ❑ Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> Legal agent (attach proof of the owner's consent to the application of the property's involved in this <br /> application and have been authorized to file on their behalf., and that the foregoing applicQtion statements <br /> are true and correct. <br /> Print Name: FranK C. Alegre Signature: 1 Date: ' <br /> Helen C. Alegre Print Name: g Signature: Date:Y Alegre �- <br /> Anthon <br /> Print Name: 9 Signature: A Date: b <br /> F <br /> Print Name: Kellie A1egr�e' Signature: date: ' <br /> Print Name: Signature: ` Date: <br /> F%0EV5VC\P1anning Application FormsWse Permit.(Revised 1.2.03) Page 5 of 9 <br />